Patient-practitioner relationship

Patient education and medication counseling are an integral part of the healthcare process. The two-way flow of information in these processes is important to improve the quality of care and patient outcomes, and to build patient-practitioner relationships. This article discusses how, through the processes of patient education and medication counseling, pharmacists can ensure that patients take their medications correctly and achieve the most beneficial outcomes of medication use. A variety of methods of communication and counseling skills are presented. 

President s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1982. Making Health Care Decisions A Report on the Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, DC Government Printing Office. 

We gave patients suffering from irritable bowel syndrome three doses of a therapeutic relationship. The lowest dose was no relationship with the medical practitioner and no treatment at all. These patients were simply assessed and put on a waiting list, with the promise that they would receive treatment some... 

Eugene Dowdle. You have not mentioned the effects of Medical Aid schemes on physician-physician and physician-patient relationships. One of the keystones of the Oslerian ethic was the sense of collegiality that bound the medical profession and provided, indirectly, a form of peer review that was of benefit to both patients and to medical practitioners. Medical Aid schemes, by their monetarising effects, have done much to damage those professional bonds. 

The dynamic between the patient and the practitioner was integral to the treatment and accordingly the themes of the relationship between the physician and the patient, and whether the physician could do the patient any good, ran throughout Forman s astrological manuals. In theory Forman was especially concerned that the physician should not meddle with supernatural... 

CRBPC s Rx D Code of Marketing Practice provides that member companies must not distribute service-oriented items or conduct "special promotions", which cannot be justified if subjected to scrutiny by members of the health professions and the public (CRBPC 2005). Acceptable service-oriented items are defined as items the primary goal of which is to enhance the healthcare practitioner s/patient s understanding of a condition or its treatment. When member companies provide hospitality, they must ensure that all hospitality is conducted within the limits of acceptable public and professional scrutiny, keeping in mind the need for an ethical relationship in any social interaction between healthcare professionals and pharmaceutical companies (CRBPC 2005). During such interactions, companies may provide participants with refreshments/meals that are modest in content and cost. In all instances, the provision of refreshments/meals must be clearly incidental. No other form of hospitality or entertainment is to be provided. 

The pharmacist in Scenario 1 is, like many practitioners, a skilled clinician. His successes as a critical care pharmacistwere supported by his formal education and his close working relationship with the medical and surgical staffs. His successes as the leader of a hospital-wide program are no more surprising. Ken simply applied the same skills he used in caring for patients to the... 

Development of a therapeutic relationship The third component of a philosophy of practice states that care is provided by establishing a therapeutic relationship between the patient and practitioner. The term therapeutic relationship has been adapted from the concept of a therapeutic alliance used in the mental health consulting professions. A therapeutic relationship is required to care for another human. 

There certainly is an art to developing a therapeutic relationship. The experiences of numerous practitioners functioning within various pharmaceutical care demonstration projects, as well as those who have built practices through trial and error, provide us with insights regarding some of the basic dos and don ts for establishing a therapeutic relationship. Some of the lessons learned from caring for thousands of patients are discussed in the section on the patient as a holistic system. 

To address the social need of drug-related morbidity and mortality based on a patient-centered approach that is built on the establishment of a therapeutic relationship, there must be clearly defined practitioner responsibilities. In pharmaceutical care, the practitioner is responsible for all drug-related needs of a patient. As discussed in detail in the next section, this means that a practitioner seeks to ensure that all therapies are appropriately indicated and that all medical conditions of a patient are appropriately treated, and that all therapies in use are effective, safe, and convenient for the patient. 

Similarly, pharmaceutical care documentation is intended to improve care delivered to patients and convey information to fellow practitioners. Three important purposes for documentation of the care delivered to patients in a pharmaceutical care practice are to (1) ensure continuity of patient care over the course of the therapeutic relationship, (2) evaluate actual patient... 

A proximate relationship between the patient s injury and the practitioner s actions (or feilure to act). 

A collegial relationship with mutual consultation and referral exists with the physicians and the CPS. Consultation with the physician or referring practitioner is outlined and co-signature is required for practice outside approved procedures/protocols. The CPS will provide patient care as a Non-Physician Clinician (NPC). A physician is available at all times by telephone or in person for consultation. Periodic chart and peer reviews, and annual evaluations provide ongoing medieation use evaluation. 

The practice of pharmaceutical care has a clearly articulated philosophy that defines values and explains what all practitioners must do. According to this philosophy, the practitioner performs the following 1) takes responsibility for meeting society s need to reduce drug-related morbidity and mortality 2) employs a patient-centered approach that addresses all the patient s drug-related needs 3) establishes a caring therapeutic relationship with individual patients and 4) assumes a clearly defined set of responsibilities that directs patient care activities. These responsibilities are to ensure that patients receive the most appropriate, effective, safe, convenient, and economical therapy to identify, resolve, and prevent drug therapy problems and to ensure that optimal patient outcomes are achieved. 

The patient care process (Fig. 1) describes how an individual practitioner fulfills the responsibilities delineated in the philosophy of practice. This process includes three distinct elements that must be completed for each patient 1) patient assessment 2) creation of a pharmaceutical care plan and 3) follow-up evaluation. The success of the process depends on the quality of the therapeutic relationship established with the patient. 

---